Came here from the podcast? You're in the right place. The break-even
calculator I mentioned is right here. Free, no strings.
I'm Rob Freels, a fractional CFO for group therapy and psychiatry practices. Most owners I talk to can name the thing that's bothering them in one sentence. What they can't do is put a number on it, so it stays a worry instead of becoming a decision. Putting the number on it is the whole job.
Nobody goes into this work because they wanted to run a small insurance company. But that's roughly what a group practice becomes: floating payroll between the session and the payment, splitting revenue, absorbing no-shows you didn't cause, and finding out in March that a payer quietly stopped paying you in November.
So when the money feels tight, or a client conversation goes badly, or you can't tell whether you can afford the hire you already know you need, it lands as a personal failure. It usually isn't. It's two systems that don't talk to each other. Your EHR counts sessions. Your bookkeeping counts money that already left. Nobody connects the two, so the biggest decisions in the practice get made on a feeling.
That's the gap I fill. Not more reports. A straight answer.
Not a 40-page deck. Not a dashboard you'll never open. An answer to the thing you've been turning over since February.
This is the one that keeps owners up, and it's answerable. What each clinician brings in, against what they cost once you count their pay, your supervision time, and their share of the overhead. Not to rank anybody — to find out what you can actually afford to offer, and to stop guessing at comp conversations.
What a new clinician has to bill before they cover themselves, how many months it takes to get there, and how deep the cash dip goes in the meantime. Ramp-up is the part that sinks people, and it's the part nobody models before they sign the offer letter.
A percentage off the top never shows up as a scary line item. It shows up as money that quietly never arrived. What you're paying, what's being collected against what should be, and which claims nobody chased. It's a real number, and most owners have never seen it.
I work with a multi-clinician group practice on exactly this. Here's what tends to show up in the first couple of months, not because any one practice is badly run, but because none of it lives anywhere your EHR or your bookkeeper would show you.
Your EHR shows the session was delivered. Your P&L shows what got collected. Neither one shows you the ones that fell in the gap: delivered, documented, never submitted. It's rarely a lot of claims. It's usually a meaningful amount of money, sitting still, already earned.
The tell: your collected-per-session and your billed-per-session tell different stories, and nobody has reconciled the two.
Most owners have never seen their contracted rates lined up side by side against the Medicare fee schedule. It's an uncomfortable exercise and a clarifying one. Usually your largest payer by volume is not your best payer by rate. Sometimes it's your worst. That's fixable, but only if you know it, and only if you walk into the conversation with the arithmetic already done.
The tell: you can name your biggest payer instantly, but not what they pay you per session relative to anyone else.
Not what they bill. What's left after their pay, their supervision, their share of overhead, and the sessions that didn't convert to cash. This is the number behind every comp conversation you've been putting off — what you can raise, what you can offer a new hire, what a fee split really leaves on both sides. Almost nobody has it, because producing it means connecting EHR session data to payroll to the general ledger, and those three don't talk.
The tell: someone asked for a raise and you had no way to answer except yes or no.
Growing costs you cash before it pays you. You pay a clinician for a session the moment it's delivered. You collect on it 30 to 60 days later. So every additional session is negative cash today and positive cash next quarter. That's how a practice can add clinicians, fill the calendar, do everything right, and feel broker in month two than it did in month one. Nothing is wrong. The money just hasn't arrived yet.
The tell: you've grown and felt worse for it, and assumed that meant you'd made a mistake.
None of this requires new software or a new bookkeeper. It requires someone to sit with the data you already have and connect it.
That's the job.
Book a 30-minute checkupSomebody asked that in a practice owners group. Twenty-two people replied and nobody answered the question. So I wrote the answer down: the rates owners report paying, why the percentages are as high as they are, and the three numbers that tell you whether yours is earning it.
Put in your clinicians, what you pay them, and your monthly overhead. It tells you how many sessions a week each person has to hold before your practice makes money, and what a new hire has to bill to pay for themselves.
It's the same model I build for clients. Free, no strings, no call required.
Every engagement starts with a free conversation. Nothing here requires a long-term contract.
For owners who want their books right and a straight read on the month.
For group owners making real decisions: hiring, comp, payer mix, expansion.
For multi-location or fast-growing groups where the stakes are bigger.
I've been a banker, an auditor, and for the last 16 years a CFO. Most of that time has been in healthcare: physician practice operations, revenue cycle, and the unglamorous work of making a practice's money actually make sense.
Today I work with a multi-clinician mental health group on exactly the problems on this page: what each clinician really contributes, what the practice can afford to add, and where the money is hiding. I'm taking on a small number of additional group practices this year.
I'm not a bookkeeper and I'm not a billing company. I'm the person who reads what they produce and tells you what it means and what I'd do about it.
Thirty minutes, free, no pitch. Bring whatever numbers you have, or none at all. By the end you'll have: